Reaching the Addicted and Underserved
We’ve all heard of the Opioid Crisis occurring in the country, but the CDC reports that a total 63,632 overdose deaths from all substances occurred in the United States in 2016. That number is rising and new efforts from health and human service agencies are attempting to address addiction as a complex, multifaceted chronic disease requiring a combination of treatment options and better delivery systems. Unfortunately, throughout the U.S., there are geographic areas, populations, and facilities with too few primary care doctors, mental health providers and addiction treatment services. In my long career as an addiction counselor, this concerns me greatly. I’ve witnessed dozens of people come in and out of treatment facility doors, but they all had one thing in common. They needed help. Unfortunately, after working a while, I realized that not every case of addiction was treated the same in the eyes of insurance……..not to mention how others were turned away because they didn’t have medical insurance at all or the financial means to undergo residential treatment. Our system is still very outdated when it comes to the treatment of addiction and the timeline set for recovery is very unrealistic. Add to that the variable access to care based on race, ethnicity, socioeconomic status, age, sex, disability status, gender identity, and residential location and it becomes even more of a complex problem. There are actual “shortage designations” in many states where facilities are eligible to receive certain federal resources for addiction treatment, particularly in rural and underserved areas. Health Professional Shortage Areas (HPSAs) are designated by the federal government as having shortages of primary medical care, dental or mental health providers and may be geographic (a county or service area), population (e.g. low income or Medicaid eligible) or facilities (e.g. federally qualified health center or other state or federal prisons). Many times, addiction treatment facilities are not available within a person’s geographic area, or do not offer culturally responsive care, or are only available after a long delay on a waiting list. Inadequate access to such facilities can exacerbate substance abuse and mental health problems, increasing costs and preventing better recovery outcomes.
I live and work in Florida in a heavily populated area and even here, Florida is among 6 states that declared opioid abuse a public health emergency in 2017. Gov. Rick Scott issued the emergency declaration in May that year enabling him to quickly allocate some $27 million in federal funds for drug treatment and prevention. Palm Beach County, Fla., itself saw nearly 600 fatal overdoses last year, mostly related to opioids. According to the executive director of the county's Drug Abuse Foundation, the emergency declaration was welcome, but Palm Beach County and the rest of the state still don't have enough publicly-funded beds available to treat people with opioid addictions and over 200 people at that time were on a waiting-list for treatment.
I believe that improving access to addiction treatment services is not just a matter of making it more affordable, but also improving service delivery models through innovative solutions leveraging health information technology. The key to delivering badly needed addiction treatment services is expanding safe, high-quality healthcare options through harnessing the power of mobile technology and enhancing digital strategies. I work now for a telemedicine company (RecoverAtHome) and provide state-of-the-art online therapy, also known as e-therapy or e-counseling and can reach more people suffering from addiction who need help. Online counseling provides substance abuse advice and support over the internet or phone. Sessions can occur through email, video conferencing, online chat, messaging, or internet phone. Online therapy can occur in real-time, such as in phone conversations and online chat rooms, or in a time-delayed format, such as through email messages. I can reach more people now to offer the tools, skills, and specialized services helping them move on in life without substances or behaviors holding them back. I realize that digital mental health services are not appropriate for everyone and that such treatment is generally less suited to more severe forms of mental illness or addiction to certain substances requiring detox. Determining the level of care needed is assessed during the initial intake and referrals can be made if needed. Still, the advantages of online therapy are many:
- It offers increased choice and flexibility and can be a motivating factor for some people to take that first step in seeking help.
- Some people prefer the anonymity of online assistance. Many frequently struggle with negative perceptions and attitudes about themselves and their substance use disorders.
- People can get addiction services without traveling to an office - and for much less money than traditional inpatient treatment.
- There is strong evidence that online therapy is as effective in reducing symptoms as therapy delivered face-to-face by a clinician.
- Online addiction counseling addresses the person’s issues where they occur….in the home and provide an affordable means of obtaining longer-term treatment shown to improve recovery and reduce relapse rates.
Ultimately, the goal of online mental health and addiction services is to improve Americans’ access to healthcare and expand the choices of care and service options. By removing barriers to addiction treatment, more Americans will lead healthy lives in long-term recovery and have universal access to quality, effective care and supports to achieve recovery, health, wellness. As Federal and State policies advance to reduce discrimination and seek solutions promoting access to treatment and recovery support services, online therapy is working to reach those who need help through an innovative approach in addressing the addiction crisis in America.